Thursday, May 24, 2007

THAT WAY LIES MADNESS

Way back when I was just beginning to practice psychiatry, I had a young woman patient (17 years old) whose name was Chris. She was one of those extremely difficult patients who we suspected of having a Borderline personality disorder (BPD) (you really can't diagnose personality disorders before the age of 18 or so)--and if she didn't have BPD, she was well on her way to developing it. She used illegal drugs and claimed they "helped" her; she was impulsive and histrionic; she cut herself frequently; made suicide attempts regularly; and was so desperate for attention and love that she would lie, cheat, and do anything for to get it. She and I had a particularly difficult session one day; and that night I happened to be on call in the emergency room. I was awakened at 2:00 am by a call from a "friend" of Chris, who informed me that Chris's body had just been recovered from the ocean, where she had gone and killed herself because she was so angry at me.

I was devastated. I remember sobbing for some time after I hung up; overwhelmed with remorse and convinced that I had chosen the wrong career. Her death was all my fault and in my sorrow I considered leaving psychiatry, since I obviously was no good at it. I thought about what a sad, wasted life Chris had lived. If only I had paid more attention to her; listened more to her pain and not expected her to control her behavior. For three hours I was in a state of abject misery and hopelessness. I would have done ANYTHING to change the fact that she was dead.

At 6:00 am the page operator put through another call to me--from Chris.

"Oh, " she told me nonchalantly, "the body they found on the beach wasn't mine"; her "friend made a mistake"; "sorry about that" and "could I see you a day early next week?"

It was then I remembered that she had been angry at me because I was planning on going on vacation next week and had told only been able to schedule her for the week after.

It was amazing how quickly my remorse turned to anger. Not for a minute did I believe that this had all been a tragic misunderstanding. No, I had been incredibly, unmistakably HAD. My emotions had been played as if they were a song composed by my patient on an instrument of her choosing. My clinical supervisor laughed (laughed!) when I told him the story, and pointed out to me that this is what it felt like to be well and truly manipulated by a pro.

And it almost worked. Hadn't I thought to myself that I would do anything to have prevented what I had thought happened?

Such behavior, he went on, was pretty typical of the Borderline patient--so, why was I shocked at what had been done to me?

Indeed. Certain behaviors are predictable, though normal people can have a hard time wrapping their minds around the whys and wherefores. The "root cause" was not my going on vacation (if you go down that route, you might as well say that the root cause was my very existence as a separate person from Chris).

Ralph Bennett argues at Tech Central Station that our tacit assumptions about the fate of 3 American soldiers captured in Iraq reflect an intuitive understanding of the nature of our enemy. One which we must at all events never acknowledge explicitly.

Think about it. If three Islamic fighters had been captured by the Americans, would there be any apprehension about their fate? Of course not. Despite all the fervid Abu Ghraib and Gitmo propagandizing of assorted leftists, pseudo-peaceniks and Democrat apologists, the general presumption is they would be treated decently.

But as soon as the news of the disappearance of these three American soldiers was released, the presumption was for the worst. For in the twisted world of Al-Qaida and its spawn of Islamofascists cruelty is first and second nature.

Not everybody reasons in this way. Some commentators are able to argue, with a straight face, that this is payback for Abh Ghraib. In fact, al-Qaeda itself maintains they are only exacting revenge for a crime committed by US soldiers

Now we have word that the body of one of the soldiers has been found, and there are reasons to believe that he suffered horribly at the hands of his captors before his death. Cruel torture and mutilation, as we know from experience with the ihadist, is part and parcel of their sociopathic and sadistic makeup--even for all their talk about Allah's "compassion and mercy." They will act out their fantasies of moral and intellectual superiority completely unaware that they are only offering proof of it utter absence.

The search continues for the other two soldiers, even as the truth we all understand is not explicitly stated.

We can expect no mercy from the barbarians we deal with. That is their nature. Not only that, we will hear repeatedly from people presumably on our own side (though whether they are on our side is becoming more and more doubtful) that our soldiers "deserved" such treatment at the hands of the enemy. Who could blame those poor jihadis for being upset at our invasion blah blah blah, and other sanctimonious intonations.

The murderous, sub-human thugs who could do this are not to be held accountable by the civilized world anymore. There will be no international court convened to try them for their atrocities; indeed, the court is too busy trying Americans for the presumed atrocities of flushing Korans down toilets and other assorted tortures against the poor, oppressed fanatics we are fighting. You will soon be made to understand that the soldier's death--all the soldier's deaths--is the fault of George Bush and Dick Cheney--the Hitlerian warmongering monsters of America.

Who knows what twisted logic makes a patient like Chris believe she is justified in behaving the way she did because, by her standards, I didn't appreciate or empathize with her plight correctly. The world is all about her needs and if the world doesn't respond adequately, then it will suffer--just as she suffers--for daring to ignore her.

At least for the Chrises of the world, there is some hope. The very fact that she came to see me week after week was an acknowledgement by her that her behavior in the world is dysfunctional and inappropriate. Underneath the pathology of her actions, she wanted to make a life worth living for herself--and she recognized she needed me to help her do it.

Chris is a beacon of mental health compared to the jihadists, who, rather than working to create a life worth living for themselves, would rather destroy yours and force you into the paranoid and malignant nightmare they choose to live in.

After I got over my angry feelings, that early episode with Chris's fake suicide actually taught me a very valuable lesson as a psychiatrist and as a person. I could not take responsibility for other people's behavior. That Way Lies Madness.

Taking responsibility for their behavior is exactly what all the terrorists of the world expect you to do. Their implicit message is that somehow YOU are the one responsible for THEIR murders. If YOU had behaved differently, then YOU would not have CAUSED THEM to behave the horrible way they did. THEY are the victims, and you are the perpetrators. That is of course the ultimate weapon of the terrorist, isn't it? To make you feel that you cause their murderous behavior? That the beheadings would not have occurred IF NOT FOR YOU?

This is the reason why you cannot negotiate with them no matter how hard you try and how much good faith you put into it.

You must put the responsibility for their actions back onto them and not permit yourself to be manipulated by their threats. If innocents suffer, it will not be because you don't pay the ransom or do what they want. Innocents suffer because the terrorists choose to make them suffer.

And those who appease and justify such behavior; or rationalize and empathize with it must ultimately share responsibility. It is they who have created the environments in which the deluded fantasies of the terrorists are able to flourish; it is they who have willing put a weapon into their hands of those who would murder and destroy; as they babble on about "root causes" and "compassion".

We know this, and yet the issue comes up over and over again, as we suffer the remorse and pain that these fanatics inflict. It is helpful to remember that terrorists inflict this pain deliberately and consciously; and that they exult at the idea of having so much power over us. As the now defunct animal Zarqawi once said very compassionately, “What is laughable is the insistence of the ministers of all infidel nationalities on the phrase ‘no negotiations’. As if there was any question of negotiation. Far from it - they must obey the demands of the Mujahadeen. If you refuse, we slaughter.”

The emotional connection between patients like Chris who, believe it or not function at a far far healthier level than a typical jihadist, is a simple one. The essence of both the borderline's and the sociopath's psychopathology is that they will try to make you feel as empty, worthless and dead inside as they themselves are.

Their sickness is that this behavior is the only pleasure they are able to experience in life. By accepting responsibility for their behavior and failing to hold them accountable, we have also placed ourselves on the path toward madness.